Role of the Committee for Physician Health (CPH) in dealing with simple addicted physicians (any accompanying psychiatric diagnoses and alleged patient damage must be dealt with separately and individually)
Role of the Committee for Physician Health of the State
of New York (CPH) in dealing with the simple physician addict
(9/13/00)- (alcohol, prescription or illegal drugs) - the
word simple assumes addiction absent any documented non-drug related
major psychiatric diagnosis or proven patient damage which should
be handled similarly but as separate issues and with no extra
punishments for the concurrent addiction.
[This speech was to be made to a meeting of CPH personel and recovering physicians from the Long Island and New York area in October, 2000. The purpose of the meeting was to improve the service of the CPH to its clients, addicted and recovering physicians, and to re-evaluate the policies of the Medical Society and CPH in dealing with these people. When I arrived at the meeting, without seeing it, The CPH wouldn't allow me to make the speech, so I handed out copies of it to those present. Of the twenty or so participants, I received one phone call concerning the issues from a recovering doctor, and no word whatsoever from the CPH or the Medical Society. Hey, what's new? Read it and judge for yourself what exactly is so threatening or destructive about my comments below, or whether it is just too assertive, real, and adult for the fearful physicians (and believe me, they were) and paternalistic CPH to handle. By the way, it has been completely and utterly ignored by the CPH and the NYS Medical Society. as well as by the recovering addicts who attended the meeting.]
I want to say hello to all of you and congratulate your being here to participate in this potentially momentous enterprise. I also appreciate being given the opportunity to address you with my thoughts. The goals of this presentation are twofold: 1) maximize public safety, and 2) maximize and enhance early addicted physician recovery and restoration.
I open my remarks with an admonition, warning, prediction, and challenge: Until we stop viewing addicted physicians as maleficent thieves from the cornucopia of forbidden pleasures, as the current psychological/superstitious paradigm of addiction suggests, we will continue to reap the whirlwind of this mistaken belief. Only by forsaking similarly biased beliefs based on misperceived, antiquated, and generalized empirical judgments about addicts and accepting the medical reality of the neurobiological and emotionally neutral basis of addiction, stated by many addictionologists but fully and completely defined and discussed in my recently published book, will public safety and physician health both be maximized. Public safety, instead of being assured by current beliefs and policies, is being severely diminished for the ubiquitous and tantalizing luxuries of moralism, revenge and punishment of the addict, and the delusion of control by addictionology, politicians and their policy offsprings, authoritarian physician licensing administrations. In fact, until we provide the safe and accepting environment where most addicted physicians routinely and fearlessly refer themselves for recovery and monitoring, unnecessary patient and physician damage will be magnified and perpetuated by the same policies putatively designed to prevent them. Thatís correct. The damage from addiction in physicians is enhanced more by the current policies meant to correct the problem, than by the problem itself. Early voluntary recovery, prior to any patient damage, is the only true method to curb and prevent patient damage caused by physician addicts. This can only be accomplished through fear-free self-referral in an public atmosphere I will describe later in the talk. The CPH is in a unique position and has the opportunity to ensure these changes if and only if it decides to. I predict that if the CPH courageously decides to make the changes it knows are correct, the best results will follow. I challenge the CPH to take this action despite its obvious fear of retaliation. So be it.
Of the many causes of potential and possible physician "impairment" leading to patient damage, addiction is the last medically based disease that is currently punishable by the Health and Education Depts. of NYS in the absence of documented behaviors injurious to patients. One of our goals tonight is to change the word "is" to "is no longer." To enhance their public image, the NYS Depts. of Health and Education, are spending inordinate time and money scapegoating harmless addicted physicians for the myriad of medical mistakes, errors, and frauds currently widespread in the field of medicine, while the real perpetrators of these damaging behaviors are being ignored, left untouched, and allowed to repeat this damage. (National Academy of Medicine studies on medical errors) The CPH must dissociate itself from these state departments and be transformed to combat, confront, and challenge the rationale and legality of the hypocritical discrimination of addicted physicians in the name of public safety until this scapegoating is stopped. Current CPH secrecy and paternalism which plays into the hands of these departments must be replaced by practical confidentiality and customer service based on the realities and facts about addicted physicians rather than by commonly held biases. The issue of what it means to be an "impaired physician" needs to be publicly and factually defined and supported.
Under the current system of dealing with addicted physicians, as truly helpful as it is compared to past systems, we are still, however, daily witnessing physician addiction associated morbidity and mortality, ruined lives, families, and practices, and other horrifying consequences stemming from addictions but more so from the public administrative reactions to these addictions. None of these is an acceptable result or is necessary to ensure public safety in dealing with addicted physicians. Improper attitudes and beliefs surrounding addictions and the consequent punitive handling of physician addicts is responsible for most of these disastrous outcomes by forcing addicted physicians underground where they are more prone to cause damage. There is a better way to handle addictions among physicians without sacrificing any public safety. In fact, the attitudes and policies I am suggesting below will, I believe and predict, increase both public safety as well as save more addicted physicianís lives and life styles.
I believe the CPH will be more effective in carrying out its mission if it adopts these suggestions, most of which have already been made by many forensic addiction specialists such as Milton Burglass, Doug Talbot, and others.
For this discussion, I will assume the CPH, as currently organized,
is sincerely motivated, is doing the best it can under its misconceived
directives and professional biases, and is truly interested in
improving its service to the medical society, the clients, and
the public. I will be outspokenly clear in my suggestions, will
not critique the current system, and will, instead, outline my
views on what I think its roles ought to be, and why. This is
the purpose of this convention. My views are based on a realistic
and scientific concept of addiction which I will heartily propound
and defend and on my own personal experiences with the CPH system
over the last eleven years. Incidentally, I am clean and sober
9 years in October. For a complete recitation of those experiences
please see the article on my web site-- http://www.nvo.com/hypoism/thedoctordrugwarwrongandwastefulp1/
Irrespective of how the public views and misperceives addiction,
we must make a clear and direct statement on the causation, course,
and recovery of addictions among physicians as well as on policies
necessary to deal effectively and safely with these addictions.
This statement must be derived from valid studies of addictions
as well as addict's documented behaviors. We must define what
a physician addict is and, most importantly, what she/he isn't.
We must derive our conclusions and policies based on these realities,
not on what we perceive to be the public's fear and irrational
beliefs or on what we fear their reactions to our policies will
be. We must rationally and fearlessly lead, not follow. Moreover,
our leadership must be active and proactive, rather than conciliatory,
diplomatic, passive, and submissive. Physician addicts are not
expendable and need not and should not be sacrificed on the cross
of current irrational beliefs about them and their addictions.
Our two critical concerns, public safety and addicted
physician recovery and restoration are not mutually exclusive.
In fact, they are parallel realities that will either both or
neither come to pass. This is so because only the correct addiction
concept or paradigm, if we find it and use it to make policy decisions,
will maximize both contingencies. This must be our goal and it
will take some work on all of our parts. This conference could
well be the beginning. There's no doubt we need a beginning.
There is a paradigm that explains the origin, etiology, pathophysiology,
course, and recovery of addictions. We just don't know what it
is yet. It is clear, however, that addicts don't volitionally
go out of their way to become defiant and deviant addicts and
public pariahs as believed by the current addiction paradigm.
The word DISEASE is appropriate and useful, besides being a reality,
to describe a condition such as this. We need to be clear that
addiction is the result of a disease and move on from that even
though the disease has not yet been completely delineated. Several
things are clear about this disease: It is not a manifestation
of a criminal mind, societal defection, immorality, or irresponsibility.
It is not a psychiatric or psychological disease in the usual
sense of these words and does not require a psychiatrist or psychologist
involved to either diagnose or ensure full, complete, and maximal
recovery. Likewise, medications of any sort are not required for
the simple addicted physician.
We also need to make public, as clearly and loudly as necessary,
the existence and outcomes of the process we are today beginning
despite any possible public reaction. If we can't clarify the
current mess surrounding physician addictions, who can or will?
Only those we don't want to.
Parenthetically, I have personally developed a purely science-based
neurobiological paradigm of addictions that more clearly derives
the following points. The correct addiction paradigm must be used
to understand and produce policies for addicts. My phone number,
address, e-mail address, book, and web site are listed at the
end of this handout for those interested in pursuing and studying
my disease paradigm further.
As a result of our new and better understanding, knowledge, and
delineation of addictions we must openly show and act on our acceptance
and comprehension of, and solidarity with, addicted physicians,
in or out of recovery. Would we treat leukemic, diabetic or arthritic
physicians differently? Addicted physicians are equally and similarly
victims of a recoverable medically-based disease. We need to make
this clear as definitively as necessary. Addiction is not willful
misbehavior as it is currently defined. Categorically, there should
be no punishment for simple addiction among physicians, only very
specific requirements for removal from and re-entry into practice
following recovery. In fact, punishment in addicted physicians
needs to be reserved for proven patient harm and non-addiction-related
crimes exactly the same as in nonaddicts. A monitored recovering
addict physician is safe and innocent unless proven otherwise,
not the other way around as is currently believed. Documented
behaviors must be the only criteria for or against addicted physicians
used in this process, not feelings, opinions, beliefs, assumptions,
generalizations, or prognostications based on them. Subjectivity,
moralistic judgments, and discretion based on these biased beliefs
must be completely removed from our policy decisions. The burden
of proof must be on the licensing agency to prove physician danger,
as in all other areas of civil and criminal law, rather than placed
on the physician to prove she/he is not - an impossible scheme.
Administrative law must be abolished for simple addictions. Moreover,
the same defendant rights must be preserved for physicians accused
of punishable actions by administrative boards as in all other
American courts. The CPH needs to be placed in a position of authority
in these areas not just advocacy. My remarks below are derived
from the above principles.
For us to resolve the role of the CPH and the Medical Society
in dealing with public safety in the face of physician addiction
while ending discrimination against and damage to these same addicted
physicians, we must develop an objective, realistic, and public
statement of the problem, its effects and solutions. The two issues
of public safety and protection of the addicted physician
are both to be addressed as equally valid and important outcomes
of this process.
Let's start with the problem and some of its realities.
- A certain number of physicians will get addicted to mood altering
substances every year. (Reality - this is the same reality as
for nonphysicians. In physicians, however, addiction must be perceived
as an occupational hazard and disease, not a personal failing
or a defection against society's laws or mores.)
- There is a valid medical disease causing these addictions.
(It is not a psychiatric disease and is not associated with psychiatric
disease and the stigma of such a designation unless there is real
objective evidence for a concurrent psychiatric disease.) The
disease of addiction needs to be defined as such and stated.
- These addicts don't get addicted voluntarily. (Destigmatization
- These addictions may be dangerous to their patients. (The
physician is not to be, however, considered and labeled dangerous
unless there is concurrent objective evidence for actual and documented
dangerousness in conjunction with the addiction. This reality
needs to be documented and studied more thoroughly and the data
published and publicized.)
- Addicted physicians should not practice medicine while addicted.
- The addicted physician needs and deserves the acceptance,
support, and assistance of his peers, medical society, CPH, partners,
and hospitals. (Destigmatization and De-ostracism of the addict.
Protection of the addict's life, livelihood, and practice.)
- Recovery from addiction is a reality and results in a viable
physician under no constraints other than those dictated by objective
monitoring. Recovery in the simple addicted physician is not a
psychiatric process nor does it require psychiatric intervention
unless requested by the addict. Recovery is the responsibility
of the addict. The CPH may guide and assist in this recovery,
but never coerce any specific treatment or deny advocacy based
on how an addicted physician eventually meets the objective requirements
necessary to return to practice. Forced psychiatric intervention
is only indicated when the need is proven for definitive
public safety indications. Psychiatric intervention is never indicated
to appease an authority. This is psychiatric abuse.
- Objective recovery from the addiction(s) is a prerequisite
to returning to practice. (Public safety)
- Relapse is a reality in the course of addiction recovery and
needs to be accepted, not punished nor used against later restoration.
(Destigmatization and Decriminalization of relapse) Special policies
must be devised to help relapsers not break criminal laws during
these unwanted, but nevertheless, acknowledged occurrences.
- Recovery can and needs to be objectified and monitored.
- The recovering physician needs to be helped financially, vocationally,
and legally as necessary during his early recovery prior to returning
to practice, especially if the licensing agencies unfairly and
interminably interfere with license restoration. (This assistance
must be provided by and funded by the medical society. Vocational
and legal support specific for recovering doctors, funded by the
medical society, to assist recovering physicians, is absolutely
- Recovery must be objectified, documented, and monitored based
on specific and objective criteria, not on any personal bias of
the CPH or licensing agency's personnel. CPH is an advocate and
monitorer, not a parent or policeman. How an addicted physician
recovers is his business alone. To return to practice only these
objective criteria must be specifically met. They will be the
same for all clients.
- Objectivity needs to rule the process. Criteria for recovery
must be public, objective, based on absence of addiction related
behavior, and clear. Discrimination by the CPH or the licensing
agencies based on personal beliefs, feelings, and opinions on
any issue have no place in this process. Behavior got us into
this mess and behavior alone will get us out of it.
- This entire process needs to be public in all aspects to assure
the public that their safety comes first, but that protection
of physicians is equally our concern. (Recovery becomes destigmatized
If the CPH is to remain in charge of this process for objective
reasons there must be a public statement by the Medical Society
to this effect explaining the above realities. All physicians
in the state, members or not, must be made aware of these realities
and their medical basis. Current and future addicts must know
what is in store for them when they realize they're addicted.
The CPH must exist for only the following reasons and these reasons
must be made known to all physicians. To avoid treatment and judgment
biases, recovering physician volunteers, not "professional"
treatment personnel or psychiatrists, need to be hired and paid
to run the CPH and fulfill the following roles:
- The primary purpose of the CPH will be to take full responsibility
independent of needs or policies of outside groups, in the name
of all physicians in the state, for dealing with addicted physicians
to ensure their helpful, fair, and equitable treatment in all
areas concerning their professional life and credentials. Their
roles and how they carry them out will be clearly and publicly
defined in writing. To assure this is accomplished, there will
be a CPH-independent advisory committee made up of volunteer recovering
physicians to oversee the CPH, take unresolved client complaints,
and report to the medical society which will be given the power
to intervene when and in any way it deems necessary to correct
CPH's shortcomings. Every physician in the state will receive
a written document defining the roles, responsibilities, and powers
of the CPH. Along the same lines, every addicted and recovering
physician in the state may voluntarily, through the CPH, make
himself known to all others. This would allow access to experience
with discrimination or recovery, networking for whatever purpose,
class action law suits by these physicians, or any other issue
on which recovering addicts would like to communicate among themselves.
A system for this networking will be duly and immediately established.
Unity of purpose and solidarity.
- The CPH will have no affiliations or connections to any outside
group but will work with and cooperate with other addict advocacy
groups where appropriate for the benefit of their clients. Independence.
- Centralize and enable the preemptive voluntary admission of
addicted physicians to begin voluntary recovery and who enter
under their own steam without fear of loss, punishment, or being
turned over to any authorities whatsoever. Fear-free access to
advocacy and recovery. Fearless entry of addicted physicians into
recovery overseen by the CPH is an absolute necessity to prevent
addicted physicians from believing they need to keep their addictions
hidden from authorities. This is the best way to prevent both
patient and client damage. Realistic Harm Prevention.
- Confront addicted physicians who display objective signs of
- Help the addicts take the appropriate measures to stop practicing
medicine and to place their practice into others' hands temporarily.
Facilitate entry into recovery.
- Protect the addict from the criminal justice system, discrimination,
and theft of his practice. (must become proactive) Protect
client's livelihood and freedom.
- Advise the addict about her/his disease, proven methods of
recovery, and assist in entering recovery. The method and path
of recovery is, however, none of the CPH's business. Advise.
- Monitor the recovery objectively according to specific and
well defined criteria. Provide, free of charge, whatever monitoring
is necessary as well as monitors as well as their easy accessibility.
Monitor and Document recovery.
- Provide free legal, financial, and vocational assistance in
cases where these are necessary before and after re-entry into
- Active, firm, and resolute advocacy in and participation in
punitive administrative license-related hearings. Active Advocacy.
- In unresolved licensure cases, provide lawyers and lawsuits
to fight discrimination and abuse of administrative discretion.
- As the recognized representative of the medical society, the
CPH will actively and publicly lobby and demand appropriate legislative
changes concerning the state's licensing and punitive powers.
Definitive and public roles of the CPH: Unity of purpose and
solidarity - Independence - Realistic Prevention - Confront addicts
- Facilitate - Protect - Advise - Monitor and Document recovery
- Assist - Advocate - Sue discriminators - Lobby the legislature.
The CPH thus becomes a trusted helper in the process of addict
discovery and recovery, not a therapist, policeman, parent, despot,
or punisher. This is accomplished while ensuring complete public
and addict safety.
As a practical summary, the following is excerpted from my book,
Hypoic's Handbook, from a chapter entitled, "Legal Discrimination."
Why couldn't the medical society and the health department get
together and say, "We know that a certain percent of our
professionals are going to become addicted. It happens like clock
work, just like outside of our profession. Some people are going
to be addicts. Let's let them know that we know this, and tell
them right off that when they find out they are addicted, they
should come to us and we will help and offer protection from the
stigmatizing world who may want to punish them. In fact, we will
defend them from criminal prosecution just in case any cops get
their hands on them, because it would be unfair to prosecute anyone
with an occupational hazard type of illness. We will provide them
with their drug of choice legally while they are preparing to
enter detox so they won't have to obtain it illegally and risk
being arrested and felonized. We will offer them places to get
detoxed and time off from their job to take care of this addiction,
as needed. No questions asked. We will not tell anyone about it.
They will not lose their jobs or reputations. We will not allow
their partners to use the addiction to steal their part of the
practice away from them. There is a law called "the Americans
with Disabilities Act" that will be changed to prevent anything
bad from happening to them because they are addicts. We need our
professionals too much to throw them away just because they became
addicted. Addicts who actually hurt a patient due to their addiction
will have to deal responsibly with that, but no addicts will be
assumed negligent or incompetent just because they are addicts.
They will get the same treatment any other professional gets when
a patient is injured, irrespective of the addiction. The only
thing we demand is that they don't go back to practice until they
are in good recovery, which will be decided by clear, specific,
and realistic criteria already made public. These criteria will
be written down on paper and will have nothing whatsoever subjective
about them. The criteria will be established by addiction specialists
and agreed upon by your medical society, including recovering
addict professionals who have no ax to grind. All will be fair,
realistic and above board."
This excerpt demonstrates the attitude we all need to exhibit
before beginning the process of re-evaluating the current system
of dealing with addicted physicians. It is realistic, assures
public safety, protects the addict, and allows for the earliest
possible entrance into recovery prior, hopefully, to the occurrence
of any disasters to patients or the addicted physicians. This
is our goal, isn't it?
Moreover, the current CPH employees must be willing to put their personal needs and desires on the line in the name of integrity to confront and demand these necessary changes from the Medical Society and the state agencies. I hope their integrity prevails in this process.
In the interest of opening this process to the public, I respectfully request this paper be distributed to all CPH participants, and, in fact, to all NYS physicians to allow and stimulate an open debate on its merits. Any and all debate on the above issues and their bases should made public as well. Secrecy surrounding the principles producing the decisions of the CPH and Medical Society is the cause of the current need for re-evaluation of the role of the CPH. When this secret policy-making ends, realistic and unbiased policy will, I predict, be forthcoming to the benefit of both public safety and all physicians of New York State. Moreover, many other state medical and professional societies need to be apprised of this work so that their members can similarly benefit from our diligence.
Dan F. Umanoff, M.D.
Author of Hypoic's Handbook, The Hypoism Paradigm of Addictions.
President and founder of The National Association for the Advancement
and Advocacy of Addicts, a not-for-profit organization offering
free educational and legal services to discriminated against and
abused addicts of all varieties, "substances" and "behavioral,"
and their families.
8779 Misty Creek Dr. Sarasota,Fl 34241, 941-929-0893,